What does Excludes 1 mean for a Chiropractor?

Confused by "Excludes 1" notes in ICD-10-CM? You're not alone!

Have you ever wondered what an ‘Excludes 1’ note on ICD-10-CM means?

Or, perhaps you are wondering: What does 'Excludes 1' mean? This note can cause a lot of confusion, and if not properly applied, can lead to claim denials and delay payment for services rendered.

An ‘Excludes 1’ note in ICD-10-CM indicates that the excluded DX code should never be used simultaneously with another DX code listed above the ‘Excludes 1’ note.

For example, 'low back pain, other' and 'sciatica of low back strain' are considered mutually exclusive and would therefore be denied as an 'Excludes 1' violation.

To avoid claim denials, providers should carefully review the ICD-10-CM coding guidelines to ensure they are using the correct DX codes for their services. They should also be aware of the ‘Excludes 1’ notes and avoid using codes that are mutually exclusive. Properly diagnosing the patient with the most accurate DX codes, without "over-diagnosing," will help prevent these denials.

Not all states are currently denying claims based on 'Excludes 1' violations, but it's crucial to remember that many states are implementing these guidelines without prior notice to providers. Your billing team should proactively keep you informed about any updates to coding guidelines, even before they are implemented in your state, to minimize the risk of claim denials. One of the first few states to adopt this change and start these denials was Illinois back in 2022.

At that time, the IL Chiropractic Society, in partnership with PayDC EHR, released a video sharing information about the 'Excludes 1' denials and how to handle them. Here is that video if you would like to learn more:

https://www.youtube.com/watch?v=9yLmmarPf18

Another great resource that can help you determine if you are in violation of ‘Excludes 1’ are online coding services such as http://www.findacode.com.Here you can easily search your DX codes and it will provide a comprehensive list of which codes are excluded. More importantly, a service like this or understand better the coding denials within Excludes 1 will help save time in insurance phone calls and will avoid delays in claim processing.

If you have more questions about how to avoid the ‘Excludes 1’ denials, or want to make sure you are using the correct codes for all the services you provide, then we invite you to connect with our team of experts by booking a consultation today! You can schedule a free discovery call with us by going to www.bushidobilling.com.

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What does Excludes 1 mean for a Chiropractor?

READY FOR A BETTER BILLING SOLUTION? WE GOT YOU!

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